ABCDE of hepatitis Flashcards
What is acute hepatitis?
Inflammation of the liver within 6 months
What is chronic hepatitis?
Inflammation of the liver that persists longer that 6 months (by molecular test rather than symptoms)
What is hepatitis?
Inflammation of the liver
Symptoms of acute hepatitis
May be asymptomatic
GI upset
Tiredness
Muscle aches
Abdominal pain
Liver capsule swelling
Jaundice
pale stool and dark urine
Signs of acute hepatitis
Tender hepatomegaly and jaundice
Signs of fulminant hepatitis (acute liver failure) eg. bleeding, ascites, encephalopathy
What would bloods show for acute hepatitis
Raised transaminases and raised bilirubin
What are viral causes of acute hepatitis?
Hepatitis A, B, D, C &E
Human herpes viruses (eg HSV, VZV, CMV, EBV)
Influenza, SARS-CoV-2
What are non-viral, infectious causes of acute hepatitis?
Spirochaetes (syphilis)
Mycobacteria (M. tuberculosis)
Bacteria (bartonella)
Parasites (toxoplasma)
What are non-infectious causes of hepatitis
Drugs
Alcohol
Other toxins/ poisoning
Non-alcoholic fatty liver disease
Pregnancy
Autoimmune hepatitis
Hereditary metabolic causes
What are signs of chronic hepatitis
May be asymptomatic
Signs of chronic liver disease:
clubbing
Palmar erythema
Dupuytren’s contracture, spider naevi
What does compensated chronic hepatitis mean?
Liver function is maintained
What would decompensated chronic hepatitis show as?
Coagulopathy, jaundice, low albumin, ascites, encephalopathy
What are other complications of chronic hepatitis?
HCC (hepatocellular carcinoma)
Portal hypertension (varices, bleeding)
What are infectious causes of chronic hepatitis?
Hepatitis B, D, C (and E)
What are non-infectious causes of hepatitis?
Drugs
Alcohol
Other toxins/ poisoning
Non-alcoholic fatty liver disease
Autoimmune hepatitis
Hereditary metabolic causes
How is hepatitis A transmitted?
Faeco-orally
contaminated food and water
In high income countries can be due to travel, sex or injecting drugs.
What is the incubation period for hepatitis A?
15-50 days (normally 14-28 days)
True or false: hepatitis A is normally asymptomatic in adults?
False - normally symptomatic including abdominal pain in pre-iteric phase
True or false: hepatitis A is self-limiting and is not a chronic disease?
True
Have 100% immunity after infection
Which immunoglobulin is raised after initial exposure to hepatitis A?
anti-HAV IgM
How to manage hepatitis A
Monitor liver function
Management of close contacts via vaccines
How many genotypes of hepatitis E are there?
4 (G1, G2, G3, G4)
How is hepatitis E transmitted?
Faeco-orally
G1 and G2:
contaminated food and water
G3 and G4:
undercooked meat (mammalian zoonotic reservoir, including pigs)
True or false: more than 95% of cases are asymptomatic?
True
Acute hepatitis is usually s____-l_____
self-limiting
In G3 and G4 of hepatitis E, there is a risk of chronic infection in i_________ patients
immunosuppressed
Rapid progression to cirrhosis
Hepatitis E can occasionally cause a____-o_-c_____ liver failure
acute-on-chronic
How to manage acute infection of hepatitis E?
Monitor for fulminant hepatitis / acute-on-chronic liver failure
How is chronic hepatitis E managed?
Reverse immunosuppression if possible
If persist despite this, give ribavirin for at least 3 months
How is hepatitis B transmitted?
Blood-borne virus
via blood and bodily fluids
Including mother-to child. Baby vaccinated at birth
also:
household contact, blood products, iatrogenic, occupational, sexual, injecting drug use
Over 95% of immunocompetent adults who get acute HBV infection, there is spontaneous r____
resolution
What can chronic HBV infection cause?
Cirrhosis, decompensated cirrhosis, hepatocellular carcinoma
What percentage of neonates/infants have development of Hep B to become chronic HBV?
90%
What does a positive result for Hepatitis B surface antigen test
You are currently infected
What is the incubation period of acute hepatitis B?
30-180 days (mean = 75 days)
How is acute hepatitis B managed?
Monitor liver function
Management of close contacts
Over 95% of acute HVC infection will have…
spontaneous resolution
What are treatment options for chronic hepatitis B?
Pegylated interferon-alpha 2a
or
Oral nucleoside analogues
What are side effects of Pegylated interferon-alphas 2a?
Flu-like symptoms
Myalgia
autoimmune conditions
Neuropsychiatric problems
Blood dysplasia
How does oral nucleoside analogues work?
Inhibit viral replication (HBV DNA polymerase)
What hepatitis B prevention is there?
Antenatal screening of pregnant mothers
Universal childhood immunisation
immunisation of healthcare workers
Screening and immunisation of sexual and household contacts
Sterile equipment in healthcare
What does hepatitis D require to replicate?
HBsAg (need surface antigen from hepatitis B to “cloak” itself and transmitt)
How is Hepatitis D spread?
Blood-borne virus
Via blood and bodily fluids
True or false: Hepatitis D can be acquired simultaneously or after HBV
True
How to treat Hepatitis D
Pegylated interferon-alpha for 48 weeks, buleviritide
How is hepatitis C transmitted?
Blood-borne
Via blood and bodily fluids
What percentage of acute HCV infections would spontaneously resolve?
30%
Testing for Hepatitis C
HCV antibody test (doesn’t show whether infection is current or not)
HCV RNA (shows whether infection is current)
HCV genotype
What treatment is there for hepatitis C?
Direct-acting antiviral therapy (DAA)
Have high efficacy, minimal side effects
8-16 weeks, one tablet daily
True or false: there is a vaccine for hepatitis C
False
no vaccine
True or false: previous infection of hepatitis C means no chance of re-infection
False
